Reverse Heart Aging? Exercise, Sleep, Diet and the Truth About Heart Health

Can you reverse heart aging—or at least slow it down?

In this episode of Baptist HealthTalk, Sandra Peebles is joined by Dr. Jonathan Fialkow, Chief Medical Executive of Integrated Services and Precision Care at Baptist Health, for a fascinating conversation about heart aging, longevity, inflammation, and the everyday habits that have the biggest impact on cardiovascular health.

Together, they break down the science behind aging hearts, explain the growing research surrounding the extracellular matrix (ECM), and separate real prevention strategies from social media wellness hype.

You’ll learn:

• What “heart age” actually means—and how it’s measured
 • Why exercise is still the most powerful thing you can do for your heart
 • How sleep affects inflammation, heart health, and aging
 • What happens to the heart and blood vessels as we get older
 • The truth about biohacking, cold plunges, and red light therapy
 • Whether supplements and stem cell therapies really help
 • Why chronic disease impacts the heart, brain, and kidneys together
 • If heart aging can actually be reversed after age 50
 • The truth about red wine and heart health
 • How lifestyle habits influence long-term cardiovascular risk

Whether you’re focused on prevention, healthy aging, or simply trying to understand what really matters for heart health, this episode offers practical, science-backed guidance you can actually use.

Host:
Sandra Peebles
Award-Winning Journalist

Guest:
Jonathan Fialkow, M.D.,
Cardiologist, Baptist Health Heart & Vascular Care  
Chief Medical Executive of Integrated Services & Precision Care
Baptist Health

If you found this episode helpful, you may also enjoy:

Heart Disease in Young Adults: Why It's Rising (and What to Watch Out For

What You Can do to Prevent a Heart Attack Today

Father-Son Cardiac Experts Debunk Top Heart Myths

Transcript

SPEAKER_00 0:00

Now, what are those lifestyle components? I'm gonna tell you the number one thing, the easiest thing, the cheapest thing that possibly impacts every part of our body, decreases every risk for every chronic disease, diabetes, heart disease, kidney disease, dementia, is exercise.

SPEAKER_02 0:15

Welcome to Baptist Health Talk, a podcast on all things healthcare, powered by Baptist Health South Florida, your trusted source for healthcare prevention and wellness.

SPEAKER_01 0:25

Hi everyone, I'm your host, Sandra Peebles. Welcome back to a new episode of Baptist Health Talk, where we answer your most searched questions on trending topics. Today we're unpacking what a lot of us really want to know. Can we reverse heart aging? We'll dive into the latest science, clear up some of the biggest myths, and share practical steps you can start using right now to keep your heart healthier for longer. We are joined by Dr. Jonathan Fialco, Chief Medical Executive, Integrated Services and Precision Care with Baptist Health. Thank you so much for being here. It's my pleasure. So let's unpack all of this. Let's get right into it. Let's start with the basics. When we speak about heart aging, what does that mean?

SPEAKER_00 1:06

It's it's good to start with the basics, and uh, I'm gonna go through a couple of concepts to kind of help the uh the listener and the viewer understand better. So obviously, uh all parts of our body age, and we are not gonna change that. It's a chronological measurement from the time we're born to the time we're measuring. But there are two connotations right now for heart aging. The first one in the general community, and if people go online, they'll probably see this first that they do searches, is regarding how to identify people at a certain stage of their life who might be at risk for cardiac disease, right? We want to prevent a heart attack. How do you start how do you prevent a heart attack? Find out who's at risk for a heart attack and lower that risk. So there are these scores that are out there that take into account your age, your gender, your race, which was recently added, because we know there are racial differences and genetics, uh, cholesterol levels, blood pressure. Do you smoke? Are you diabetic? Do you have a family history? And it puts it into these calculators. And it comes back where in the past it gave us a number, like you're over 10% risk, a 12% risk of a heart attack. That didn't resonate. So now it's reported as a heart age. So if I'm 65 years old and it comes back, my heart age is 75, it's saying, hey, you're at high risk for a heart attack, and there's things you can do to lower it. So the heart age in the general uh vernacular is regarding these scoring systems to tell you what's your risk for cardiac events and how do you stand compared to others? The other, perhaps more exciting aspect of heart aging has to do with this new area regarding longevity, lifestyle medicine, but really getting into more biochemical and physiological mechanisms of what's going on in our body that advances what is associated with aging. So, why do some people get worse cardiovascular problems as they get older, others don't? What are those interventions? And by learning these aging components, the question is can we reverse it? Maybe we can't reverse it, but can we stabilize it, install it? So there's two aspects the heart age score, which if people go online, they'll see, and it puts into these parameters of what's my risk, and then more on the scientific basis, what's actually going into my heart? What are the elements that are being discovered to lead to the what happens with the heart with aging? And again, perhaps as targets for treatment to keep people heart healthier.

SPEAKER_01 3:07

So, what are the changes that the heart goes through? Because we hear about people getting older. The older you are, the more likely you are to survive a heart attack. So the average person might think, well, my heart is actually stronger when I'm older. Yeah.

SPEAKER_00 3:18

In a way. So, first place, there's no golden rule. Everyone's different, everyone has different lifestyles, everyone has different experiences, environmental factors, genetics. But as we get older, certainly in Western civilization, we know the heart and the blood vessels do have a couple of changes. The heart muscle tends to get stiffer. So the heart muscle is meant to be very compliant, almost like a soft bag. So you fill it with fluid, it expands and squeezes. It gets stiffer. So when it fills with fluid, it gets a little, the pressure goes up, and that can lead to people to start getting symptoms of shortness of breath, fluid retention, even heart failure. The blood vessels become stiffer. They could become inflamed. Inflamed blood vessels can rip and lead to blood clots. Blood clots are heart attacks and strokes. So the physio, the physical changes in our heart muscle cells, our valves become thicker and stiffer. They're meant to be very easily opening and closing to let the blood go through the heart and its normal circulatory process. When the valves become stiffer or leak, it puts more pressure on the heart. So you have valve changes, the blood vessels become stiffer, more inflamed, can lead to blockages and blood clots, and the heart muscle itself becomes stiffer. Those are generally age-related changes.

SPEAKER_01 4:23

We hear a lot about the heart muscle, of course, but there's something we're going to talk about today, which is called extracellular matrix, ECM. What is it, especially for a person that's not a scientist? Try to explain what this is and why are we talking about this today?

SPEAKER_00 4:37

Try to keep it relatively simple because these are obviously very complex systems. The um actually I'll go back a little bit because I always love the history of medicine. I mean, when I always look at something new, which something we're trying to do is, how do we learn that? Where did it come from? But if we think about this, up until about the 16th century, we had medicine which was based on grossly looking at things. We saw blood, we saw our liver, we saw whatever. And this goes back towards Babylonian and early Greece. With the invention of the microscope, medicine took its first quantum leap because now we can look at things at a smaller level. And we saw that this organs and bodies are made up of cells. Cells are these little, you know, cubes almost, and the cells have certainly functions. And the more cells you have builds up the more organs. And now for hundreds of years, we thought that the cells were kept together by what's called an extracellular matrix. Extracellular outside the cell matrix is a support substance. So all the cells in our body were held together by this extracellular matrix. We are now finding that it's not just a support structure to keep the cells together, but the extracellular matrix actually has physiological functions. It produces certain other substances, um collagen and various other things that pull cells together. It releases certain proteins and chemicals. So the analogy I use, especially as a preventive cardiologist and a lipid specialist dealing with cardiometabolic disorders and obesity, is for decades we thought our adipostytes, our fat cells, which are storage of cells of energy, right? They go in your belly, you'd have them in parts of your body, you'd look at them, they'd be filled with fat for storage. They did nothing. But we've learned over the last decades they are highly functional organs. Your fat cells produce hormones and chemicals that lead to inflammation, which can lead to heart disease and diabetes and dementia and stuff. So now we're at the level with this extracellular matrix as another area that we did not think had any function other than holding cells together. Now, the reason that's relevant is as we build the models to reproduce the extracellular matrix, maybe we can develop targets for intervention. Maybe we can develop tools, medicines, lifestyle changes to make that extracellular matrix healthier. And that might be one of the drivers of heart aging. So by doing so, we can keep our heart muscle cells healthier and prevent the aging process.

SPEAKER_01 6:43

When we say we can tweak it, well, what well, precisely my next question is that there's been a study that indicates that uh there might be a possibility of intervening, if we, if you will, uh in that ECM and and maybe making it more pliable. Is is that what is that what the goal would be?

SPEAKER_00 7:08

The heart muscle, right? Heart muscle is a muscle, you want to squeeze and relax and squeeze and relax. One of the aging processes we find the heart muscle cells don't squeeze and relax. And we know it's not the cells, it's the matrix. So if we find, because this matrix is not healthy for reasons I guess we'll discuss, we can, and then as a result of an unhealthy matrix, it makes the heart muscle cells stiffer. So we're getting to the root cause. It's not the cells of the heart muscle, it's the substance around the heart muscle. How do we prevent it from creating that proteins and collagens and fibrous tissues that stiffen the heart muscle? Is it a target? Now the question is do we directly do activities to the extracellular matrix? More commonly and probably it's we do other things that will then positively impact the extracellular matrix. Okay. So the extracellular matrix may not be the driver of it, it might be the result of it. But we know that the aging of the heart is in the extracellular matrix.

SPEAKER_01 7:58

Okay, so then here's obviously the forced question. And what we all want to know is what we can do. Does lifestyle, the way we eat, exercise, stress, do all of these play a role in ECM? I mean, are we, when we are doing cardio, actually strengthening or having some kind of effect on that ECM?

SPEAKER_00 8:14

It's it's actually the you know, the million-dollar question. Um and and where I sit, you know, I always break people's, I always break people's health needs down to where they are in their health continuum. So for example, if I have a person who's 65 years old, 50 pounds overweight, smokes five cigars a week, and there's nothing good about smoking cigars, high blood pressure, high color, correct, high blood pressure, but they'll say, all right, I don't inhale, smoke. No, no, your nicotine's absorbed through your cheeks, it's still a toxic substance, et cetera. But having said that, meaning they have an unhealthy lifestyle. They get four hours of sleep, they snore, they have sleep apnea, and they're like, well, I want to take this pill because it's gonna make my extracellular matrix better. Good luck. It's not gonna make a difference. So if that person's more on their chronic disease spectrum with a further along, we need to improve their lifestyle, the other metrics. If I have someone else who's, let's say, healthier or earlier on in their course, and they want to say, hey, listen, I want to start getting involved in this more lifestyle medicine, longevity type of processes. What's out there that may not be in the conventional medical wisdom, what do I do? Then we would approach it differently. So going back to the main question, no one, no one is gonna stay healthy unless they have a healthy lifestyle. No matter what pill you take or what juice you take or what infusions you get, if you smoke, you're not gonna have, you know, you're gonna have a negative impact on your health. We wanna keep a healthy diet, and we could talk about what that means, but certainly keep your weight under control. Blood pressure control, uh, lipid control, which is cholesterol, triglycerides. Obviously. Now, what are those lifestyle components? I'm gonna tell you the number one thing, the easiest thing, the cheapest thing that positively impacts every part of our body, decreases every risk for every chronic disease, diabetes, heart disease, kidney disease, dementia, is exercise.

SPEAKER_01 9:50

You had me on the edge of my seat. You had me on the edge of my seat.

SPEAKER_00 9:54

We evolved hunting for animals, walking to get water. You know, we will, we, we, when we go to our, when we look at studies of these nativist tribes that have not had civilization, you know, we're talking about trying to do seven or ten thousand dollars, 10,000 steps a day. They're doing 80, 90,000 steps a day in terms of their activities. And exercise doesn't cost anything. You don't have to join a gym, you don't have to buy equipment. You can do five minutes, eight minutes, ten minutes of push-ups and sit-ups, or just walking in place in front of a TV. But if people can develop a 30-minute, five times a week habit of just walking, just doing anything, every part of our body improves, including the functions of our extracellular matrix. So don't lose sight of exercise. Sleep. Fortunately, sleep has been established over the last couple of years. I was very much involved in sleep medicine, cardiovascular is going back 15, 20 years ago, and you don't you guys see? Don't you guys see? And now it's become established that sleep has restored properties, decreases inflammation and oxidation, which are buzzwords for cardiovascular disease. So people really have to concentrate on their sleep. We stay up later, we look at screens, we are eat late at night, distracted with so many things.

SPEAKER_01 10:55

And we're so busy.

SPEAKER_00 10:57

It's hard to find the time because people work hard, they're in traffic, they take care of the kids. They want a few hours of pleasure at night, which might just be vegetating in front of the TV. So you don't want to shorten that.

SPEAKER_01 11:07

But that is also uh a stimulus that does not help you sleep and keeps that central nervous.

SPEAKER_00 11:12

Alcohol at night, caffeine in the afternoon. So learn good sleep habits, improves your extracellular matrix, include improves all those chemical, hormonal, physiological changes that increase your aging process. And then obviously things like we said, not smoking, things like eating a proper diet. To me, people say, What do I eat? We can get into details. Everyone's different, but no one's gonna argue that ultra-processed and processed foods are healthy and refined sugars and starches are healthy.

SPEAKER_01 11:38

So all of this, all of it makes sense. And my question, actually, my next question was what is that one thing we can do to keep our heart healthy? I mean, you obviously mentioned many of them, but do you think staying active that makes sense?

SPEAKER_00 11:50

Exercise is number one. But again, you can't smoke three packs of cigarettes a day, we probably can't exercise, but whatever. But exercise is number one and what you could do in your own. But but what is that one thing? I'm gonna turn it around a little bit. One thing we can do is be aware of your cardiac risk, whether it's through, you know, online thing, online scores, certainly through a primary care doctor or preventive cardiologist, because there are things out there you don't feel. For example, if someone's blood sugar starts creeping up, meaning they're on their way to diabetes, we know that there's been stress on their pancreas affecting their insulin-producing cells for probably 20 years before the sugar goes up one L one one point. If someone's got some plaque in their coronaries, hopefully found by a calcium score and not by an event like a heart attack or a stroke, we know that started 20, 25 years before they got to the point where they're getting the inflammation in the arteries. So the earlier you see your doctor, you look at the certain markers to see if there's any signs of inflammation or markers of chronic disease, start talking and learning what are those healthy lifestyles, the better. It's easier to prevent something from developing than when it happens to stabilize it and prevent it from getting worse. We do that and we do it well, but better they get what we call primordial prevention before it even starts. Let's nip it in the bud. So the one thing would be start assessing your lifestyle and what are those chronic disease risks, specifically towards cardiovascular disease. And you can do that on your own. You have to be aware. It's not one thing. It's not my cholesterol's high, it's not my blood pressure's little up. It's all these things together get put in a blender and they come out with what's my aging, what's my risk of a heart attack and stroke and death.

SPEAKER_01 13:23

And it's so interesting because in this conversation, that's what I'm feeling. I'm realizing how everything is so interconnected, clearly.

SPEAKER_00 13:29

You have to approach it holistically. You can't look at one thing and exactly.

SPEAKER_01 13:31

It's not just my heart. It's gonna be also my pancreas, my liver. All of these things are gonna be affected.

SPEAKER_00 13:35

Main organs that are affected by the inflammation of chronic disease are your can't your kidneys. And we have a world, I mean, it's it's an epidemic of early kidney disease not recognized. And people should get a urine every year looking for protein, looking for creatinine. They see there's a lot of people walking around with early kidney failure. You can't bring back your kidney cells once they're gone. Uh, brain, obviously, a lot of the early dementia of dementia starts early. We always concentrate on Alzheimer's, which probably is related to some inflammatory conditions, but there's also something called vascular dementia, which is truly the blood vessels, and of course, heart attacks, which can be heart attack, where you actually damage your heart muscle, death from cardiovascular components, heart failure, where you live with the damaged heart muscle, which is a miserable existence, and stroke. So if you're looking at the main organs, the brain, the heart, and the kidneys that require the most blood flow, those are the three that are most impacted by the unhealthy lifestyle and the chronic disease. But yeah, kid um, um, pancreas, um, your digestive system. There are many other parts of our body that are affected by the chronic disease that's epidemic in the United States.

SPEAKER_01 14:34

You have said so many things that I think we could do a whole other podcast. A short amount of time, too, right? Do it. No, each one of the things you said is like, well, that would be make a great podcast. I'd like to talk about that.

SPEAKER_00 14:43

But get back to that root cause. But let's it's an unhealthy metabolism from our epid from our environment, from our lifestyle. There are things we can't control. Pollutants in the air lead to inflammation, things in the water. We're looking at micro microplastics and things like that, but there are many things we can't control.

SPEAKER_01 14:57

So a lot of people go on the internet and they see all these promises, supplements, stem cells, uh, stem cell treatments. Do you think that there are things out there that are not, I don't want to say a magic bullet, but a per something like that will propel you to better health, or do you think it's all hype?

SPEAKER_00 15:12

Uh I I don't think it's, I think the hype is a I think the hype is aware of the science. That doesn't mean it's bad. And even when it comes to, and I'll give you my perspective, because I work with folks and if we're talking about supplements or some of the genetic and genomic tests, where it sits. So for again, decades, we as uh medical practitioners have made our decisions based on what's called evidence-based care. Evidence-based care and the protocols that started in the 1980s are based on clinical trials. You take a group of people and you have a condition and you say, let's take half of them and do this, and half of them and not do this, and after a period of time, you get an outcome. Example. Let's take we let's say we take a bunch of 65-year-old men who have a heart attack. And half of them will get put on a statin, and half won't get put on a statin. And 10 years later, you find, oh my God, 25% less of the people who got the statin had a heart attack. So we know statins can prevent heart attack. But not everyone who got a statin didn't have a heart attack, not everyone who got the statin didn't. So we base it on populations. We based it on um on these trunk, these, these, these statistics. We're moving into the area of precision medicine, which is not what's my percent chance of this because of this, but what do I actually have? So when you're talking about stem cells, you're talking about the ECM testing, when we're talking about some of these other scans or blood tests or markers, it's not how do my numbers compare to others, which is how we've looked at medicine, right? I can't tell you, again, I have smokers who are 90 years old. I have 60 year old marathon runners who have a heart attack. You can't define it to the individual. We want to be humble to know we don't know everything. And the more precise we are, we can apply the resources appropriately. So, what that means is if we're looking at stem cells, fascinating technology, been there for a long time, really haven't established a major broad indication, but certainly, you know, with things like bone marrows, things like that, it makes a difference. In the cardiovascular space, it's promising, but I wouldn't sit there and say, I'm gonna smoke and eat what I want because they'll have stem cell therapy 10 years from now. I wouldn't rely on that as a means of affecting my decisions. It might be something to offer a small set of people down the road. So the science is growing. We're we're doing incredible work to get to that root cause of what's causing the disease and maybe reversing it, but so much work still to be done to educating our population and guiding them on not getting the disease in the first place, which I think is really what we're talking about.

SPEAKER_01 17:24

So many believe that once that heart has started aging, it's all downhill from there and there's nothing they can do. Once we're at a certain age, say past 50, past 55, uh, do you think there are lifestyle changes that you can adopt to make a difference?

SPEAKER_00 17:37

So again, I I tend to take what you ask me, and I'm gonna take a different differential answer to that. You know, and again, what I do, it's like, well, I'm 65, I should have calcium in my arteries. At 75, it's okay to have a heart attack. The answer is absolutely not. Uh there were these great studies that are done, and there's one that people could look up. It's on the internet, the Timani tribe study, T-S-I-M-A-N-E. Basically, I'm gonna paraphrase the trial. A group of um researchers went into the Bolivian Mountains to an indigenous tribe, and they followed them for a period of time, and they measured what they ate and how much they slept and and their activities and social activities. At the end, they did certain heart testing on them, and there was like no heart disease. 82-year-olds, 81-year-olds, nothing, clean arteries. Which means as human beings, we are not meant to develop heart disease, vascular disease.

SPEAKER_01 18:20

They're not watching TVs.

SPEAKER_00 18:21

They're not. Well, they're walking 80,000 steps a day. They go to sleep when the sun goes down, they wake up when the sun comes down. They're breathing clean air. They eat, you know, natural tubers and roots and meat and fish, and they're not eating anything from a bag. They eat no sugar. It doesn't exist. So we're not meant to get heart disease. Having said that, in Western civilization, you know, you're gonna live and you wanna go to the movies and you want to have popcorn and you want to go to a restaurant, and you want so we have to balance between what is fun but what is unreasonable. So we do expect some aging of the heart. First question is is it natural and does it have to happen? No. Is it gonna happen with all likelihood based on our current Western lifestyle? To some degree, yes. Minimize it, make it occur later, that's fine. Second question is, can you reverse it? And that's what we're kind of looking at. We are seeing certain people with certain lifestyles and certain genetic risks and certain levels of certain diseases, atherosclerosis, that with really aggressive lifestyle intervention, they actually reverse it. Their arteries can actually open up a little bit, the muscles, the heart muscles come a little more compliant. Certain things when they get deposed, collagen, fibrous tissue, you know, we talked about the fascia and things, we can't make that go away, but we can make it less impactful by stopping it from developing further. Dementia, for example, one of the goals in dementia is can we make it better? Maybe, but if we can arrest it early in this process and not get it worse, that's one of our target goals. So we're still learning about the reversal, but just don't let it happen in the first place. Or if it's early, stop it from getting worse.

SPEAKER_01 19:46

There's a lot of talk about biohacking. It's a it's a cool term nowadays, how we can kind of cheat our own system. Cold plunges, uh, red light therapy, things of that nature. Do you think there's any value in those treatments?

SPEAKER_00 19:58

The short answer is I do, but in its right place. So, for example, very healthy younger people, which seems to be this a big part of this clientele. They they they have some disposable income or they get their information from social media, and they're pretty healthy and they want to biohack their body for additional health, maybe contrary to our environmental factors, which you can't otherwise change. Uh, I think there probably is some benefit to decreasing the inflammation, some mental stability, and maybe some components to it. We'll see. But you're not gonna take an unhealthy person with chronic disease and put them in a cold plunge and don't change anything else. But I get that. I have people who are very unhealthy meeting me and they want the direction. And they're like, but I take an Asai smoothie in the morning. I'm like, knock yourself out. But again, the cigarettes and the not exercising and the belly being the first thing to enter into room, we got to work on that. Asai is not gonna do it.

SPEAKER_01 20:47

What about this idea of the placebo effect? Say, if I believe that I'm gonna make myself better, so I'm gonna do the cold plunge and I'm gonna start eating healthier and I'm going to determine, I determine that I will be better and I'm going to improve my heart health. Do you think that there's something in that?

SPEAKER_00 20:59

So that's a brilliant question and concept. And the answer is we don't know. That's where clinical trials come into play. So when we go back to the evidence-based medicine, part of the benefit of that trial design is to avoid a placebo effect. A placebo effect would mean if I do this in 500 people and I don't do it in 500 people and both groups say I felt better, then whatever we did is a placebo effect, right? Um, and actually, interestingly, well, I'll get into another point. So placebos are okay if you think about this. When I was in my training in the 1980s in New York City, I worked at an inner city hospital, any city hospital inner city hospital, and we had a lot of people coming in, drug addicts withdrawing from heroin. And if you ever saw someone withdrawing from heroin, they're in distress. I mean, their bodies are convulsing, their blood pressure is 250 over 150, their pulse is 150. And we would put an IV in and we'd say, We're giving you some morphine, we're giving you some morphine, and we're giving them saline. Now it's one thing to say, I feel better, placebo effect. But their blood pressure came down to normal. Their heart rate came down to normal. So placebos can have physiological benefits. Especially when it comes to pain and sensations of well-being. Now, a little bit after that, it became unethical to use placebos. We stopped it. But we're thinking about that again in a medical ethical standpoint. If the goal is to make the person feel better and this activity makes them feel better, what's so wrong with that? Now, again, that's a different story.

SPEAKER_01 22:16

Well, I'm one of those positive thinkers. I always like to say I'm doing something for my health and it's But there's also something called a nocebo effect, which is the negative effect of with no action.

SPEAKER_00 22:25

And we deal with that a lot. Statins are a classic example. If you put someone on a statin and tell them it might call muscle aches, they're 20 times more likely to say my muscles ached than if you didn't tell them anything. Now their muscles are aching, they're feeling it, but it's a it's not from the medication. So we have to be careful with that. Now, these people feel better, great. They're not ignoring other aspects of their health, great. Do the cold plunge, do the infusions or whatever. I mean, my threshold's low if it's not dangerous. There are some dangerous things out there people are doing. That's a different story. But is it really benefiting them? We won't know unless we do clinical trials, which we probably won't do because they'll be expensive. But as I said, not at the expense of doing something that's smart. I'll share another anecdote, which, you know, for the listeners and viewers. Patient of mine, very, very successful gentleman in his mid-40s, horrible genetics, um, South Asian, um, which has horrible metabolic disorders, advanced caronyl disease in the early 40s, overweight, diabetic. Got him tuned up. He's doing great, lost weight, his metabolism. I mean, this guy's feeling great, every number's great. And he calls me in a panic. Uh, something's wrong. I think it, I think it's because I'm on generics. I have to change my generics. Uh, I'm gaining weight, and blah, blah, blah. I'm like, that's not the generics. What are you doing? He says, come over. So he had me over his house. He showed me as a private chef. First thing as he showed me his meal, had a lot of carbohydrates and sugars, but okay. And then he shows me at the end, look at what I'm doing. He had 27 supplements and six juices he takes every night. A carrot, ginger, turmeric juice, tons of sugar. A beet juice, tons of sugar. And what was probably happening was not only was he increasing his sugar and processed, but all those supplements were probably inhibiting him from absorbing his medications, which he needed with his vascular disease and diabetes, which was corrected. So you can overdo it. Stop it for two, three weeks, everything came back perfectly controlled and normal. So, in that world of people of biohacking or wanting the extra longevity, that's where you want to discuss with an educated practitioner, not a skeptic to say, not a cynic to say, no, no, no. Hey, there's a lot in medicine we don't know, and not everything follows the conventional Western medicine treatments of take a pill for everything, but also be aware of what we don't know and don't do it at the exclusion of what we do know. And I think that's where it's going. Having said that, it's fascinating. I'm very attuned to that world. Uh, some of the concepts are right, but I think it's a little more hype than actual established proof at this point.

SPEAKER_01 24:41

Okay. I left one of my favorite questions kind of towards the end. And I love to ask cardiologists. I don't know if I'm gonna get a different reaction from you. Okay. Truth or not, or myth. Is red wine good for our heart?

SPEAKER_00 24:56

Um myth.

SPEAKER_01 24:57

Myth, of course.

SPEAKER_00 24:58

Okay. So it doesn't change from doctor to doctor. I keep trying. No one's gonna argue that alcohol in any form has any positive benefits. Having said that, you know, small amounts and people were otherwise healthy. I have no, I don't think anyone's gonna, I don't think you'd live longer or shorter by having a glass of red wine five times a week or et cetera, et cetera. You'll other things will affect you. Um, but don't drink red wine or any alcohol because you think it's good for your health. And the danger, quite frankly, is from a public health standpoint, there are people with drinking problems who can justify it by saying, at least I'm helping my heart. And we don't want that message.

SPEAKER_01 25:30

Yeah, and I didn't mean to be, you know, joking about it because, you know, you know, we kind of like our our alcohol, but the reality is that it is a lot of confusion out there. There's a lot of Exactly, and and that's one of those myths that won't die. And so I think it's important to ask.

SPEAKER_00 25:41

It has some association with certain diets that are very low carb, they drink red wine, the old French cut paradox and stuff, but but no.

SPEAKER_01 25:46

Well, when it comes to research on heart and aging, the ECM is changing the way doctors are are thinking, right, about treating, even preventing disease. Um, what can you tell us about the role specifically of ECM and our future?

SPEAKER_00 26:00

Well, well, like I said, I think it's become another target for research to determine what leads to these aging components of our heart. The question is, is it, does it change because of other activities, or is it something we can direct therapy to, right? And that's where I think the science will show us. But knowing that we have a major part of our body's construct that's physiologically active that we didn't think was, I think is the first really exciting part. So the ECM, again, deserves traction, deserves more information, but I don't think people should start going to the doctor and saying, How's my ECM doing? You can determine that by your sleep, your exercise, your labs, your lifestyle.

SPEAKER_01 26:34

So there's no actual test.

SPEAKER_00 26:36

There's no test, look at there's no in the in the scientific world, the academic world with doing things, but there's nothing out there in the conventional space.

SPEAKER_01 26:42

That the patient can go and say, give me a test. Nothing they should have, let's put it that way. On extracellular matrix, I want to repeat it for those that are just listening to the colour.

SPEAKER_00 26:49

You can look at things like you can look at fibrous function, you can look for collagen and stuff like that, but no.

SPEAKER_01 26:53

So looking towards the future, lifestyle changes that people can can adopt, or looking at research, medical research, what gives you the most hope for our heart health in the future?

SPEAKER_00 27:03

Uh again, I split things into groups. From a chronic disease standpoint, which is the majority of our population, about 40-50% of our population have one or more chronic diseases. Many of them don't know it. Hypertension, elevated cholesterol, elevated triglycerides, a little obesity, you know, sugar going up, sleep apnea. So, my exciting part is I think we're getting more aware of targeting the underlying lifestyle that leads to the inflammation and those drivers, processed foods, et cetera, et cetera, than just my cholesterol's high, take this pill, right? It's been a long time. I have this test result, I need to be on a pill. I'm excited that we're getting more to the root causes. On the other part, which is let's say the lifestyle medicine, the longevity type of component, the excitement is like the ECM, the things we're learning, the things we're experimenting with, to say how can we prevent the inflammation that occurs or mitigate and decrease the inflammation that might occur through things we can't control. So for the people who are already on that disease path, identifying them, helping them get healthier to don't wind up with the bad chronic diseases, dementia, heart attacks, kidney failure. But for the other, let's say younger, healthier people, being able to give them opportunities to stay healthier beyond just what they're already doing, I think is exciting and well. They're kind of divergent because they're different populations in terms of people in the community. Ultimately, it'd be nice if all the older chronic disease people, you know, wind up getting healthier and everyone's healthier, but you have to approach people where they are, right? So again, if I have a 35-year-old tech guy who wants to biohack, different conversation than the 65-year-old who, like I said, the belly's the first thing that comes in and their kidney function is already bad and the sugar's creeping up a little bit. I'm not going to be talking about cold plunges. I'm going to be talking about more established uh medical therapies.

SPEAKER_01 28:42

What a fascinating conversation. Dr. Fiaco, I have really enjoyed it. And like I said, I I heard like five different podcasts, if not more, from our conversation. It was fascinating. Thank you so much. My pleasure. I'm sure it was of great service to our viewers. Um, thank you so much for sharing that insight with us and with our viewers. And for you, make sure that you hit that subscribe button on our channel here to keep up with the latest health and wellness information and tips, of course, from our experts. Thank you for watching.

SPEAKER_02 29:09

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